户丽;梁佳;金树英;韩焱晶;卢峻;图娅;

• 1:北京中医药大学针灸推拿学院
• 2:中国中医科学院研究生院
• 3:中国中医科学院针灸研究所

摘要(Abstract)：

近5年来,针刺治疗抑郁症的作用机制研究取得了显著进展,笔者对此进行了综述,主要包括以下几方面:(1)针刺上调海马内单胺类神经递质、γ-氨基丁酸含量和5-羟色胺1A受体结合位点,及下丘脑神经肽Y、β-内啡肽、μ受体的表达,降低海马谷氨酸含量;(2)针刺上调海马脑源性神经营养因子蛋白及基因和相关受体的表达,激活腺苷酸环化酶-环磷酸腺苷(cAMP)-蛋白激酶A-cAMP反应元件结合蛋白信号通路;(3)针刺增加海马生长相关蛋白-43水平,并抑制c-Jun氨基末端激酶活性和细胞凋亡;(4)针刺增加海马胶质纤维酸性蛋白的表达;(5)针刺调节下丘脑-垂体-肾上腺皮质轴和下丘脑-垂体-性腺轴功能;(6)针刺下调血清中细胞因子的含量。笔者还对今后的研究进行了展望。

关键词(KeyWords)： 针刺;抑郁症;慢性应激;机制

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(No.81102638、No.81173334);; 北京中医药大学自主选题项目(No.2011JYBZZ-JS 067)

作者(Author): 户丽;梁佳;金树英;韩焱晶;卢峻;图娅;

Email:

参考文献(References)：

• [1]Luo H C,Jia Y K,Zhan L.Electroacupuncture vs.amitripty-line in the treatment of depressive states[J].J Trad ChinMed,1985,5(1):3-8.
• [2]罗和春,Halbriech U,沈渔邨,等.电针与氟西汀治疗抑郁症疗效的对照研究[J].中华精神科杂志,2003,36(4):215-219.Luo H C,Halbriech U,Shen Y C,et al.Comparative studyof electroacupuncture and fluoxetine for treatment of depres-sion[J].Zhonghua Jing Shen Ke Za Zhi(Chin J Psychiatry,Chin),2003,36(4):215-219.
• [3]Duan D M,Tu Y,Chen L P,et al.Efficacy evaluation for de-pression with somatic symptoms treated by electroacupuncturecombined with Fluoxetine[J].J Trad Chin Med,2009,29(3):167-173.
• [4]Zemlan F P,Garver D L.Depression and antidepressant the-rapy:receptor dynamic[J].Prog Neuropsychopharmacol BiolPsychiatry,1990,14(4):503-523.
• [5]徐世芬,庄礼兴,唐纯志,等.针刺与埋线干预对抑郁大鼠中枢单胺类神经递质的影响[J].中国针灸,2007,27(6):435-437.Xu S F,Zhuang L X,Tang C Z,et al.Effects of acupunctureand embedding thread on central monoamine neurotransmittersin the depression model rat[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),2007,27(6):435-437.
• [6]朱艺,刘群英,卓廉士.电针对抑郁大鼠5-羟色胺和乙酰胆碱酯酶在海马表达的影响[J].针刺研究,2009,34(1):16-20.Zhu Y,Liu Q Y,Zhuo L S.Influence of electroacupuncture of“Baihui”(GV 20)and“Sanyinjiao”(SP 6)on hippocampal 5-HT and AChE immuno-activity in chronic depression rats[J].Zhen Ci Yan Jiu(Acupunct Res,Chin),2009,34(1):16-20.
• [7]康汇婷,王朝伟.电针对慢性应激抑郁模型大鼠海马5-HT1A受体的影响[J].河南中医,2010,30(1):38-40.Kang H T,Wang C W.Effect of electroacupuncture on 5-HT1Areceptor of hippocampus of the rat model with chronicstress depression[J].Henan Zhong Yi(Henan Trad ChinMed,Chin),2010,30(1):38-40.
• [8]夏晓红,宋晓鸽,张圭,等.电针百会穴对吗啡戒断抑郁大鼠中枢单胺类递质的影响[J].安徽中医学院学报,2009,28(5):44-45.Xia X H,Song X G,Zhang G,et al.Influence of electroacu-puncture of Baihui(GV 20)on central monoamine neurotrans-mitters in morphin withdrawal induced depression rats[J].Anhui Zhong Yi Xue Yuan Xue Bao(J Anhui Trad Chin MedColl,Chin),2009,28(5):44-45.
• [9]周胜红.针刺对女性更年期抑郁症患者的疗效及其对DA、NE、5-HIAA的影响[J].中国针灸,2007,27(5):317-321.Zhou S H.Therapeutic effect of acupuncture on female’s cli-macteric depression and its effects on DA,NE and 5-HIAAcontents[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),2007,27(5):317-321.
• [10]Moghaddam B,Bolinao M L,Stein-Behrens B,et al.Glu-cocoticoids mediate the stress-induced extracellular accumula-tion of glutamate[J].Brain Res,1994,655(1/2):251-254.
• [11]刘海静,何新芳,陈兴华.针刺对抑郁模型大鼠行为学及海马氨基酸类神经递质的影响[J].医学研究杂志,2010,39(3):79-81.Liu H J,He X F,Chen X H.Effects of acupuncture onpraxiology and hippocampal amino-neurotransmitter in ratstreated with chronic stress[J].Yi Xue Yan Jiu Za Zhi(J MedRes,Chin),2010,39(3):79-81.
• [12]Husum H,Kammen D,Termeer E,et al.Topiramate nor-malizes hippocampal NPY-LI in flinders sensitive line‘de-pressed’rats and upregulates NPY,galanin,and CRH-LI inthe hypothalamus:implications for mood-stabilizing andweight loss-inducing effects[J].Neuropsychopharmacology,2003,28(7):1292-1299.
• [13]Burnett F E,Scott L V,Weaver M G,et al.The effect ofnaloxone on adreno-corticotropin and cortisol release:evi-dence for a reduced response in depression[J].J Affect Di-sord,1999,53(3):263-268.
• [14]Lee B,Shim I,Lee H J,et al.Effects of acupuncture onchronic corticosterone-induced depression-like behavior andexpression of neuropeptide Y in the rats[J].Neurosci Lett,2009,453(3):151-156.
• [15]李建兵,王欣君,王玲玲,等.β-内啡肽及其受体对电针抗抑郁快速起效作用的影响[J].南京中医药大学学报,2011,27(5):441-444.Li J B,Wang X J,Wang L L,et al.The influence ofβ-en-dorphin and its receptor on electro-acupuncture’s quickeffects on anti-depression[J].Nanjing Zhong Yi Yao Da XueXue Bao(J Nanjing Univ Trad Chin Med,Chin),2011,27(5):441-444.
• [16]Duman R S,Malberg J,Nakagawa S,et al.Neuronal plas-ticity and survival in mood disorders[J].Biol Psychiatry,2000,48(8):732-739.
• [17]卢峻,时宇静,费宇彤,等.抑郁症与神经可塑性[J].中国心理卫生杂志,2006,20(1):43-46.Lu J,Shi Y J,Fei Y T,et al.Depression and neuroplasticity[J].Zhongguo Xin Li Wei Sheng Za Zhi(Chin Ment HealthJ,Chin),2006,20(1):43-46.
• [18]卢峻,杨秀岩,华茜,等.cAMP反应元件结合蛋白:抗抑郁药信号转导通路的交汇点[J].生理科学进展,2008,39(4):371-374.Lu J,Yang X Y,Hua Q,et al.CREB:the convergent pointof signal transduction pathways of antidepressants[J].ShengLi Ke Xue Jin Zhan(Progr Physiol Sci,Chin),2008,39(4):371-374.
• [19]Dwivedi Y,Rizavi H S,Shukla P K,et al.Protein kinase Ain postmortem brain of depressed suicide victims:altered ex-pression of specific regulatory and catalytic subunits[J].BiolPsychiatry,2004,55(3):234-243.
• [20]Duman R S,Nakagawa S,Malberg J.Regulation of adultneurogenesis by antidepressant treatment[J].Neuropsycho-pharmacology,2001,25(6):836-844.
• [21]孙健,刘健华,王谦,等.电针对抑郁症大鼠海马组织AC-cAMP-PKA信号通路的影响[J].中国老年学杂志,2010,30(24):3672-3674.Sun J,Liu J H,Wang Q,et al.Effect of electroacupunctureon AC-cAMP-PKA signal transduction pathway in hippocam-pus of depression rats[J].Zhongguo Lao Nian Xue Za Zhi(Chin J Gerontol,Chin),2010,30(24):3672-3674.
• [22]徐世芬,庄礼兴,唐纯志.针刺对抑郁大鼠海马神经因子表达的影响[J].广州中医药大学学报,2009,26(6):532-534.Xu S F,Zhuang L X,Tang C Z,et al.Effects of acupunc-ture on expression of neurologic factors in hippocampus of de-pression rats[J].Guangzhou Zhong Yi Yao Da Xue Xue Bao(J Guangzhou Univ Trad Chin Med,Chin),2009,26(6):532-534.
• [23]卢金花,姜劲峰,王玲玲,等.电针治疗抑郁模型大鼠快速起效海马区BDNF-TrkB机制研究[J].针灸临床杂志,2011,27(5):51-54.Lu J H,Jiang J F,Wang L L,et al.Rapid-effect mechanismon BDNF-TrkB in hippocampus of depressive model rats byelectroacupuncture[J].Zhen Jiu Lin Chuang Za Zhi(J ClinAcu-moxi,Chin),2011,27(5):51-54.
• [24]符文彬,刘健华,白艳甫,等.电针对抑郁症大鼠海马CREB-BDNF受体后信号转导通路的作用[J].中国老年学杂志,2009,29(23):3038-3042.Fu W B,Liu J H,Bai Y F,et al.Effect of electroacupunc-ture on CREB-BDNF postreceptor signal transduction path-way in hippocampus of depression rats[J].Zhongguo LaoNian Xue Za Zhi(Chin J Gerontol,Chin),2009,29(23):3038-3042.
• [25]段冬梅,图娅,陈利平.电针不同穴组对抑郁大鼠行为活动及海马p-CREB表达的影响[J].中国针灸,2008,28(5):369-373.Duan D M,Tu Y,Chen L P.Effects of electroacupunctureat different acupoint groups on behavior activity and p-CREBexpression in hippocampus in the rat of depression[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),2008,28(5):369-373.
• [26]Kim H,Park H J,Han S M,et al.The effects of acupunc-ture stimulation at PC 6(Neiguan)on chronic mild stress-in-duced biochemical and behavioral responses[J].NeurosciLett,2009,460(1):56-60.
• [27]韩焱晶,李文迅,贾宝辉,等.电针对抑郁模型大鼠海马脑源性神经营养因子基因表达的影响[J].中国中医基础医学杂志,2011,17(9):1004-1006.Han Y J,Li W X,Jia B H,et al.Effect of electroacupunc-ture on the expression of hippocampal brain derived neurotro-phic factor in depression rats[J].Zhongguo Zhong Yi Ji ChuYi Xue Za Zhi(Chin J Basic Med Trad Chin Med,Chin),2011,17(9):1004-1006.
• [28]梁佳,卢峻,崔善福,等.针刺对抑郁模型大鼠皮层及海马脑源性神经营养因子基因和蛋白表达的影响[J].针刺研究,2012,37(1):20-22.Liang J,Lu J,Cui S F,et al.Effect of acupuncture on ex-pression of brain-derived neurotrophic factor gene and proteinin frontal cortex and hippocampus of depression rats[J].Zhen Ci Yan Jiu(Acupunct Res,Chin),2012,37(1):20-22.
• [29]黄兴兵,沐楠,梅芳,等.针药结合治疗老年抑郁症的疗效及对血清脑源性神经营养因子水平的影响[J].实用医学杂志,2011,27(1):127-129.Huang X B,Mu N,Mei F,et al.Therapeutic effect of acu-puncture combined with medicines for the aged depressionand its effect on the level of serum brain derived neurotrophicfactor[J].Shi Yong Yi Xue Za Zhi(J Pract Med,Chin),2011,27(1):127-129.
• [30]梁佳,李卫东,吴元坪,等.电针对慢性应激抑郁模型大鼠海马神经元凋亡与再生的影响[J].中华中医药杂志,2012,27(4):947-950.Liang J,Li W D,Wu Y P,et al.Effect of hippocampal neu-rons apoptosis and regeneration on chronic stress depressionmodel rat treated by electroacupuncture[J].Zhonghua ZhongYi Yao Za Zhi(Chin J Trad Chin Med Pharm,Chin),2012,27(4):947-950.
• [31]韩焱晶,李文迅,贾宝辉,等.电针对抑郁模型大鼠海马一氧化氮-环磷酸鸟苷信号转导通路的影响[J].针刺研究,2009,34(4):236-241.Han Y J,Li W X,Jia B H,et al.Effect of electroacupunc-ture on hippocampal NO-cGMP signaling pathway in depres-sion rats[J].Zhen Ci Yan Jiu(Acupunct Res,Chin),2009,34(4):236-241.
• [32]戴巍,李卫东,卢峻,等.电针对慢性应激抑郁大鼠海马神经元凋亡及JNK信号转导通路的影响[J].针刺研究,2010,35(5):330-334.Dai W,Li W D,Lu J,et al.Effect of electroacupuncture onhippocampal apoptosis and JNK signal pathway in chronicstress depression rats[J].Zhen Ci Yan Jiu(Acupunct Res,Chin),2010,35(5):330-334.
• [33]Webster M J,O’Grady J,Kleinman J E,et al.Glial fibril-lary acidic protein mRNA levels in the cingulate cortex of in-dividuals with depression.bipolar disorder and schizophrenia[J].Neuroscience,2005,133(2):453-461.
• [34]Liu Q,Li B,Zhu H Y,et al.Glia atrophy in the hippocam-pus of chronic unpredictable stress-induced depression modelrats is reversed by electroacupuncture treatment[J].J AffectDisord,2011,128(3):309-313.
• [35]Michelson D.Chronic imipramine is associated with dimi-nished hypothalamic-pituitary-adrenal axis responsivity inhealthy humans[J].J Clin Endocrinol Metab,1997,82(8):601-606.
• [36]陈华德,金灵青,娄冉.电针百会穴对慢性应激抑郁模型大鼠HPA轴的影响[J].浙江中医药大学学报,2010,34(2):252-253.Chen H D,Jin L Q,Lou R.Effects of electroacupuncture onBaihui(GV 20)for hypothalamic-pituitary-adrenal axis ofchronic mild stress depression model rat[J].Zhejiang ZhongYi Yao Da Xue Xue Bao(J Zhejiang Univ Trad Chin Med,Chin),2010,34(2):252-253.
• [37]张瑜,王亚军,田永萍,等.针药结合治疗对慢性应激抑郁模型大鼠HPA轴的影响[J].中国中医药科技,2011,18(3):175-180.Zhang Y,Wang Y J,Tian Y P,et al.Effects of acupuncturecombining with medicine treatment on HPA axis of rats withchronic unpredictable stress[J].Zhongguo Zhong Yi Yao KeJi(Chin J Trad Med Sci Technol,Chin),2011,18(3):175-180.
• [38]杨梦,王朝伟,康汇婷.针刺百合、太冲穴对慢性应激抑郁模型大鼠HPA轴的影响[J].现代中医药,2011,31(2):54-55.Yang M,Wang C W,Kang H T.Experimental research ofthe effect of needling acupoints Baihui and Taichong on HPAaxis of rats with chronic stress depression[J].Xian DaiZhong Yi Yao(Mod Trad Chin Med,Chin),2011,31(2):54-55.
• [39]梁佳,卢峻,王俊仁,等.不同针刺方法对慢性应激抑郁大鼠下丘脑CRH基因表达及血清ACTH、CORT的影响[J].北京中医药大学学报,2012,35(4):265-268.Liang J,Lu J,Wang J R,et al.Influences of different acu-puncture methods on hypothalamic CRH mRNA expressionand serum ACTH and CORT in rats with chronic stress de-pression[J].Beijing Zhong Yi Yao Da Xue Xue Bao(J Bei-jing Univ Trad Chin Med,Chin),2012,35(4):265-268.
• [40]游伟,时宇静,韩焱晶,等.电针对慢性应激抑郁模型大鼠糖皮质激素及其受体基因表达的影响[J].针刺研究,2010,35(4):261-266.You W,Shi Y J,Han Y J,et al.Effect of electroacupunc-ture of“Baihui”(GV 20)-“Yintang”(EX-HN 3)on the ex-pression of glucocorticoid and glucocorticoid receptor mRNAof the chronic stress model rats[J].Zhen Ci Yan Jiu(Acu-punct Res,Chin),2010,35(4):261-266.
• [41]乌云,孙兴华,邢越.透刺对脑卒中后抑郁干预作用及对血浆皮质醇水平的影响[J].上海针灸杂志,2011,30(3):153-154.Wu Y,Sun X H,Xing Y.Intervening effect of point-to-point acupuncture on post-stroke depression and its influenceon plasma hydrocortisone levels[J].Shanghai Zhen Jiu ZaZhi(Shanghai J Acu-moxi,Chin),2011,30(3):153-154.
• [42]郭爱松,李爱红,顾一煌,等.针刺联合氟西汀对卒中后抑郁症疗效及HPA轴功能的影响[J].交通医学,2007,21(5):496-497.Guo A S,Li A H,Gu Y H,et al.Effects of acupuncturecombined with medicine on hypothalamic pituitary adrenalaxis in post stroke depression patients[J].Jiao Tong Yi Xue(Med J Comm,Chin),2007,21(5):496-497.
• [43]李强,尚翠侠,马现仓,等.抑郁症患者的性激素分析[J].中国神经精神疾病杂志,1999,25(5):271-273.Li Q,Shang C X,Ma X C,et al.Sex hormone abnormalitiesin depressive patients[J].Zhongguo Shen Jing Jing Shen JiBing Za Zhi(Chin J Nerv Ment Dis,Chin),1999,25(5):271-273.
• [44]周胜红,郝巧光.针刺对女性更年期抑郁症患者血清FSH、E2的影响[J].辽宁中医杂志,2007,34(7):980-981.Zhou S H,Hao Q G.Effect of acupuncture on feminine hor-mone in climacteric age depression women[J].LiaoningZhong Yi Za Zhi(Liaoning J Trad Chin Med,Chin),2007,34(7):980-981.
• [45]Levine J,Barak Y,Chengappa K N R,et al.Cerebrospinalcytokine levels in patients with acute depression[J].Neuro-psychobiology,1999,40(4):171-176.
• [46]Song C,Halbreich U,Han C,et al.Imbalance between pro-and anti-inflammatory cytokines,and between Th1and Th2cytokines in depressed patients:the effect of electroacupunc-ture or fluoxetine treatment[J].Pharmacopsychiatry,2009,42(5):182-188.
• [47]孙华,赵慧,张捷,等.针刺百会、足三里对抑郁症患者血清炎性细胞因子水平的影响[J].中国针灸,2010,30(3):195-199.Sun H,Zhao H,Zhang J,et al.Effect of acupuncture atBaihui and Zusanli on the level of serum inflammatory cyto-kines in patients with depression[J].Zhongguo Zhen Jiu(Chin Acu-moxi,Chin),2010,30(3):195-199.
• [48]王曙辉,杨丽霞,崔星.电针结合头面部围剿按摩对抑郁症细胞因子的影响[J].中国中医急症,2009,18(1):41-42.Wang S H,Yang L X,Cui X.Effect of electroacupuncturecombined with massage on the levels of serum cytokines inpatients with depression[J].Zhongguo Zhong Yi Ji Zheng(JEmerg Trad Chin Med,Chin),2009,18(1):41-42.